Guiding therapy by coronary CTA better than standard care alone in patients with angina

Coronary computed tomography angiography (CTA) is consistently effective in reducing the rate of death from coronary heart disease (CHD) or nonfatal myocardial infarction (MI) across subgroups in patients with stable chest pain, as shown in a recent study, noting plausible underlying mechanisms.

A total of 4,146 participants were randomly assigned to either standard care alone or standard care plus coronary CTA. The primary endpoint of death from CHD or nonfatal MI was explored by symptoms, diagnosis, coronary revascularizations and preventive strategies. This open-label trial assessed the consistency and mechanisms of the 5-year reduction in this endpoint.

There were consistent event reductions across symptom and risk categories (p-interaction=NS). Coronary CTA resulted in a decreased incidence rate of the primary endpoint (0.23, 95 percent CI, 0.13–0.35 vs 0.59, 0.42–0.80 per 100 patient-years; p<0.001) in patients who were not diagnosed with angina due to CHD.

Patients who had undergone coronary CTA had higher rates of coronary revascularization in the first year (hazard ratio [HR], 1.21, 1.01–1.46; p=0.042) but lower beyond 1 year (HR, 0.59, 0.38–0.90; p=0.015). Rates of preventive therapies throughout follow-up (p-all<0.001) were also higher in patients assigned to coronary CTA, with rates highest in those with CT-defined coronary artery disease.

In addition, modeling studies exhibited the plausibility of the observed effect size.

“Coronary CTA improves coronary heart disease outcomes by enabling better targeting of preventative treatments to those with coronary artery disease,” the investigators said.